The present invention relates to resorbable ceramic scaffolds for use in biological applications, and their method of production. Specifically, this invention relates to novel scaffolds, formed via a replication, or relic technique, and useful as biological replacements for hard tissue.
Bone grafts formed of porous calcium phosphates (CaP) show potential as a scaffolding for the growth of new bone in applications such as spinal fusion, long bone fractures, non-union fractures, bone defects, and hip revisions. In current medical devices, the porosity is either randomly distributed, or the manufacturing techniques have limited ability to control pore size. Control of pore distribution and size may be advantageous in optimizing bone growth into the graft.
Bone grafts are used in the repair of significant fractures, the treatment of skeletal tumors, spinal fusion, and the reconstruction of failed total arthroplasties. Autogenous bone, or autograft, is bone harvested from another location in the patient, and used as the graft. Autograft performs very well in the applications cited above. The disadvantages of autograft include the limited supply of excess bone in the patient, as well as the inherent risks of morbidity and recovery pain taken by performing a second surgery. Allograft, bone taken from another human, has the advantage of being in larger supply than autograft bone. However, the greater immunogenic response of allograft, and risk of viral contamination or risk of transmission of live virus to the recipient, have led to the decline in use of allograft bone as a bone graft material. Xenograft, or bone grafts taken from another species, often elicits acute antigenic response. In the vast majority of cases, xenograft fails in its role as a graft material.
Synthetic bone graft materials have been described in Bone Graft and Bone Graft Substitutes: A Review of Current Technology and Applications; Damien and Parsons; J. Applied Biomaterals, Vol. 2, 1991, pages 187-208, which is incorporated herein by reference. The ideal graft should be able to support a load equivalent to the bone that is being replaced, so that the newly formed bone can remodel to the same quality and dimensions of the original bone that is being replaced. Ideal graft is also osteoactive, enhancing the formation of new bone. This is achieved both by the chemical nature of the material, as well as the structure, or architecture of the graft. Structurally, the graft needs to be porous to allow for ingrowth of the new bone. Though no optimal pore size has been established, the size of the pores required for good bone growth is between 100 and 500 microns. The ability to tailor the pore size and distribution is also viewed as a method of enhancing bone growth. Load support can be achieved by having the supporting phase of the graft three-dimensionally connected.
The materials in bone graft substitutes include, but are not limited to, plaster of Paris (calcium sulfate, CaSO4.1/2H2O), tricalcium phosphate (Ca3(PO4)2), hydroxyapatite (Ca10(PO4)6(OH)2), calcium phosphate cements, calcium aluminates, the family of Bioglass(copyright) (composed of SiO2, Na2O, CaO, and P2O5), apatite-wollastinite glass-ceramics (AWGC), polymers such as polymethylmethacrylate (PMMA) or polyhydroxyethylmethacrylate (PHEMA), and blends of the above. They may be in the form of loose particles, particles bound in polymer or other carrier material (a paste), ceramic precursors that react when blended together (calcium phosphate cements), porous solids, or loose fiber constructs (such as felts), or textile processed fibers (weaves, braids, or knits).
The disadvantages of using loose particles as a bone graft include the difficulty of handling them, the tendency of the particles to settle (or pack tightly) into the defect, the inability of loose particles to support load, and particle migration away from the defect site in bodily fluids. Particle settling results in two problems. First, when the particles pack together, the pore size is reduced in the graft to less than 100 xcexcm. This pore size does not allow the migration and ingrowth of cells into the graft. Particle settling also results in an inability to control the pore size and distribution in these systems. The size and distribution of pores in these types of grafts are determined by the size of the particles and how they pack together. Since settling is not controllable, there is no ability to use graft architecture to control new bone growth into the graft.
Particle migration from the sight results in possible tissue irritation and undesired tissue response in the regions were the particles eventually settle.
Particle settling and migration problems have been mitigated to some extent by the use of synthetic or natural matrix materials, including polymers such as PMMA, polysulfone (PS), or polyethylene (PE), which are not resorbable, and ceramics, such as plaster of Paris. Particles have also been enclosed in tubes of resorbable polymers, such as collagen or polyglycolide. The size and distribution of pores in these types of grafts are also not controllable. The distribution is determined by the size of the particles, how they pack together, and the space between them caused by the carrier matrix. As with loose particles, there is limited ability to use graft architecture to control new bone growth into the graft. Load support is also limited, since the graft substitute is in the form of a soft paste, and the load-supporting phase of the graft is not three-dimensionally connected.
For bone grafts in the form of cements, there is also a limited ability to control the pore size and distribution. Pore creating agents may be put into the cement prior to its formation. However, the size and distribution of pores are determined by the size, form, and concentration of the agent, resulting in the inability to use graft architecture to control new bone growth into the graft. This inability to control pore size and distribution also results in limits in load support capability. A random distribution of pores results in a random distribution of defects in the structure. So, although the load-supporting phase of the graft is three-dimensionally connected, these types of grafts have shown low load support capability.
Control of the pore size and distribution in porous solid bone grafts is also limited. Porous solid bone grafts have been formed using the replamine process on naturally occurring coral. Here, the pore size and distribution is limited to that of the species of coral used. Defect location is also uncontrollable, lowering the load support capability of the graft in a fashion similar to that discuss above for cements. Pore creating agents may also be put into a ceramic prior to its formation. But, as is the case with cements, the size and distribution of pores are determined by the size, form, and concentration of the agent.
Bone grafts in the form of textile architectures, such as weaves, braids, or knits, have advantages over the other forms of bone grafts. Textile technology may by used to precisely place the fibers in a desired location in space, allowing for a large degree of control in the size and distribution of pores in the bone graft structure. However, since there is no interconnection of fiber in three dimensions, load support capabilities of grafts of this type are limited.
There are a number of woven structured formed with fibers composed of the materials found in bone graft substitutes cited in the prior art. Tagai et al., in U.S. Pat. Nos. 4,820,573, 4,735,857, and 4,613,577, disclose a glass fiber provided for the filling of a defect or hollow portion of a bone. In this case, the calcium phosphate glass fiber may be in the form of short fibers, continuous fiber, or woven continuous fibers. In this prior work, the load support capability of the graft is limited since there is no interconnection of fiber in three dimensions.
To increase the strength of the fiberous implants, bioresorbable fibrous constructs have been filled with polymers to form composite structures. Many of these have been cited in the prior art. U.S. Pat. No. 5,013,323, to Kobayashi et al., discloses an implant material for replacing hard tissue composed of calcium phosphate glass fibers in an organic polymer, where some of the glass fiber on the composite surface is exposed to the living tissue to promote bonding of the device to the tissue.
In U.S. Pat. Nos. 5,721,049, 5,645,934, and 5,468,544 (all to Marcolongo et al.), disclose composite materials formed from bioactive glass or ceramic fibers. The preferred embodiments are braids or meshes of bioactive glass or ceramic fiber interwoven with structural, non-bioactive fibers impregnated with a polymer to form a composite of suitable biocompatibility and structural integrity. The braid or mesh is designed so that the bioactive fibers are concentrated on the surface of the implant.
A method of producing biodegradable prostheses comprising a composite of resorbable fibers reinforcing a biodegradable matrix is disclosed in U.S. Pat. Nos. 4,655,777 (Dunn and Kasper), and 4,604,097 (Graves and Kumar). The fibers include ceramic powders, xcex2-tricalcium phosphate, and a biodegradable glass. In this case, the fiber/polymer composite is made in the laminated form, and not as a woven structure.
The limitation of the composite approach is that by filling in the space between the fiber, the structures themselves are no longer porous. So, they are unable to support the ingrowth of new bone. As discussed earlier, pore creating agents may also be put into the composite prior to its formation. However, as pointed out for earlier structures, the size and distribution of pores are determined by the size, form, and concentration of the agent.
The fibers produced in the patents cited above have a wide variety of compositions, and were formed by various techniques. In most cases, they are composed of mixtures of silicon dioxide (SiO2), aluminum oxide (Al2O3), calcium oxide (CaO), sodium oxide (Na2O), potassium oxide (K2O), lithium oxide (Li2O), magnesium oxide (MgO), zinc oxide (ZnO), strontium oxide (SrO), iron oxide (Fe2O3), titanium oxide (TiO2), zirconium oxide (ZrO2), calcium fluoride (CaF2), and phosphorous pentoxide (P2O5). These compositions are melt spun at temperatures between 800 and 1700xc2x0 C. A discussion of the range of spinnable, degradable glass compositions, and how they are processed, is discussed in U.S. Pat. No. 4,604,097 (Graves and Kumar).
The forming of bioactive ceramic bodies from precursor solutions has also been previously discussed. In one work (U.S. Pat. No. 5,074,916 to Hench et al.), alkali-free bioactive compositions were prepared by a sol-gel route. In this approach, alkoxysilane and calcium nitrate are dissolved in a blend of water and nitric acid. After a period of time, the solution forms a gel, which is dried and heat treated to yield a fine calcium-silicate-phosphate glass powder. The powder can be remelted and formed into final shape using traditional glass processing techniques. The inventors claim process, compositions, and powders forms of the glass. No mention is made, however, of the ability to control the pore size and distribution in the final device.
In another patent (U.S. Pat. No. 4,897,370, to Horiguchi et al.), a process for preparing bioceramic composite sintered bodies is claimed. Here, the starting materials are silicic acid ester, alkyl phosphates, calcium alkoxyls, and inorganic particulates and/or whiskers. The inorganic phase is used as reinforcement to the glass or glass-ceramic phase formed by reaction of the precursors. The above mention materials are mixed in water in a sequence which results in gelation of the mixture. The gel is dried, compacted, and sintered to yield the composite body. As in other prior art, no mention is made of the ability to control the pore size and distribution in the final device.
In summary, the prior art presents a number of methods for forming synthetic bone grafts. In all cases, the forming techniques lack the ability to tailor the pore size and distribution in the graft, and/or the ability to have the supporting phase of the graft three-dimensionally connected. Tailored pore size is viewed as a method of enhancing bone growth, while improved load support is achieved by a three-dimensionally connected supporting phase.
It is therefor an object of the present invention to provide a bone graft in which the pore size and distribution is tailored to enhance bone growth, and improved load support is achieved by a three-dimensionally connected support phase.
Another object of this invention is to create structures to use as scaffolds for the in vitro or in vivo growth of human or animal tissue, such as bone or cartilage. These scaffolds can be used as implant materials for the replacement of defects or hollow portions of hard tissue resulting from external injury or surgical removal of hard tissue tumors. Their composition can be tailored such as to be resorbed by the body at a rate equivalent to the rate at which natural hard tissue grows into the above mentioned defects or hollow portions of hard tissue.
A still further object of this invention is the formation of laminated bioresorbable structures where each layer has controlled pore size and distribution. This type of structure has another degree of control for optimizing bone growth into the resorbable ceramic structure if the structure is used as bone graft.
We have discovered a process for making three-dimensionally connected bioresorbable ceramic structures for use as bone replacement materials in which pore size and distribution are controlled. The process comprises impregnating an organic fabric with a metal and phosphate ceramic precursors that will provide a bioresorbable ceramic when sintered; heat treating the structure to decompose the organic fabric and any nitrates that may be present to form an unsintered biocompatible ceramic implant device. The unsintered device may thereafter be sintered to form a bioresorbable ceramic. The advantage of this work over biocompatible inorganic structures disclosed in the past is the ability to both control pore size and distribution for optimized bone ingrowth, as well as for a three-dimensionally connected ceramic structure with load support capability.